Provider Demographics
NPI:1053537647
Name:DWYER, ALICIA LEA (DDS)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:LEA
Last Name:DWYER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 146
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4705
Mailing Address - Country:US
Mailing Address - Phone:972-556-2414
Mailing Address - Fax:972-869-3509
Practice Address - Street 1:9400 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 146
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4705
Practice Address - Country:US
Practice Address - Phone:972-556-2414
Practice Address - Fax:972-869-3509
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice